Study to Assess Factors Influencing Initiation, Adherence, and Completion of Tuberculosis Preventive Therapy Among Household Contacts of Pulmonary Tuberculosis Patients in Vijayapura District

Abstract

Background: India has the highest burden of Tuberculosis (TB) infection globally, nearly 35-40 crores of which an estimated 26 lakh are likely to develop active TB. Although early diagnosis and treatment of active TB remains a top priority in India, preventing TB by detecting and treating TB Infection (TBI) is an important step towards ending TB. Tuberculosis preventive treatment (TPT) is one of the key interventions recommended by the World Health Organization (WHO). The risk of developing TB disease is reduced by 60% after receiving TPT. In July 2021, NTEP issued new guidelines recommending TPT for all House-Hold Contacts (HHCs) of Bacteriologically confirmed pulmonary TB cases. There is very little literature on the initiation and completion rates of TPT. Knowledge about the current scenario and programmatic challenges would help in future improvision of the programme. Objective: 1. To estimate the Proportion of HHCs (Household Contacts) of Bacteriologically confirmed Pulmonary TB who initiate and complete the TPT in Vijayapura district. 2. To explore the Factors influencing Adherence and Non-Adherence to TPT treatment. 3. To understand operational difficulties for non-initiation and non-completion of TPT by interviewing concerned health care providers and informing programme and policymakers. Methodology: This Cross-sectional study was conducted in a high burden district in Northern Karnataka by Interview Technique using a pre-tested semi-structured questionnaire. All HHCs of Bacteriologically confirmed Pulmonary TB cases registered from June 2022 to December 2022, who were eligible for TPT were enrolled in the study. The HHCs were interviewed From March 2023 to July 2023. Out of 10 TB units, five units were selected using a simple random sampling method. TB patients were selected from these 5 TB units using the probability proportional to size sampling method to achieve the sample size. HHCs of those TB patients were interviewed after agreeing to participate in the study. Results & Conclusion: Total 565 HHCs interviewed in 119 households with average HH size of 5. 81% pf households were holding BPL card, 59% overcrowded and 78% Hindu by religion. We found that 22% of the HHCs/study participants told they were not screened for TB (even not for clinical symptoms) to start TPT and 21% of the study participants were not initiated on TPT, and 50% of those initiated did not complete the full course of TPT. The reasons for non-initiation were as follows: 56% lacked awareness about TPT, 32% told they were not approached by any healthcare provider regarding TPT, 6% were Unwilling, and another 6% had medical conditions that prevented them from being prescribed TPT. The most common reason for not completing the full course of TPT as told by 48% was it was not necessary to take complete TPT. Other reasons mentioned were: Unavailability of medicines (6%), not receiving drugs after 3 months (12%), discontinuation due to adverse effects (15%), and some medical conditions and migration (9%). The study highlights the prevalent social factors and stigma associated with the TB disease, with a 55% non-response rate when approached for study participation. To address these factors and improve TPT outcomes, the study recommends several strategic interventions like introduction of shorter TPT regimens to enhance adherence, improved training for Health Care Personnels to ensure effective TPT delivery, addressing programmatic issues like ensuring steady drug supply, establishment of IGRA testing facilities, expanding health insurance coverage, and intensifying targeted IEC activities to reduce stigma and foster a stronger acceptance of TPT within communities.